Vascular and microvascular anastomosis is considered to be the foundation of plastic and reconstructive surgery, hand surgery, transplant surgery, vascular surgery and cardiac surgery. In the last two decades innovative techniques, such as vascular coupling devices, thermo-reversible poloxamers and suture-less cuff have been introduced. Intra-operative surgical guidance using a surgical imaging modality that provides in-depth view and 3D imaging can improve outcome following both conventional and innovative anastomosis techniques.
Optical coherence tomography (OCT) is a noninvasive high-resolution, high-speed, 3D imaging modality that has been adopted widely in biomedical and clinical applications. Since its invention in the early 1990s, OCT has been widely used for diagnosis, therapy monitoring and ranging. However, innovation in the field of surgical precision has failed to provide in-depth view and 3D guidance for microvascular surgery.
An important parameter to determine the surgical outcome is whether the blood flow has been restored. Because vessels are so delicate, endothelial injury, mal-positioned or partial thickness sutures can induce turbulence or thrombosis. If the thrombosis occludes the vessel lumen with no flow distally, all the previous steps have to be redone. However, sometimes the thrombus formation is not immediate or the thrombus is not large enough to completely occlude the vessel. In such a situation, visual input from an optical microscope can deceivingly show flow restoration.
Further, a suture technique described by Alexis Carrel and awarded the Nobel Prize in 1912 utilizes precise placement of sutures to connect two ends of vessels together. However, this technique has remained a challenge for surgeons to master, and thus requires the highest level of skill and surgical expertise, especially for small vessels smaller than 1 mm in diameter.
What is needed are systems, methods and apparatuses that can assist in inter-operative decision-making processes and to avoid post-operative complications while helping to improve surgical precision.